Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: Results from five pooled cohorts

Research output: Contribution to journalArticle


Background: Smoking and nicotine exposure increase insulin resistance and the risk of type 2 diabetes. Swedish smokeless tobacco (snus) is high in nicotine, and its use is prevalent in Scandinavian countries, but few studies have investigated snus use in relation to diabetes risk. Objective: To explore the association between snus use and risk of type 2 diabetes using pooled data from five cohorts. Methods: Analyses were based on prospective studies conducted between 1990 and 2013 including 54 531 never-smoking men and 2441 incident cases of type 2 diabetes identified through screening, self-reporting and hospital and prescription registries. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed and adjusted for age, body mass index, educational level, alcohol consumption and physical activity. Results: Compared to never users, the HR of type 2 diabetes was 1.15 (95% CI: 1.00-1.32) in current users of snus. In individuals consuming 5-6 boxes per week, the HR was 1.42 (95% CI: 1.07-1.87); in those consuming ≥7 boxes per week, the HR was 1.68 (95% CI: 1.17-2.41). Each additional box of snus consumed per week yielded an HR of 1.08 (95% CI: 1.01-1.16). Conclusion: Our findings indicate that high consumption of snus is a risk factor for type 2 diabetes. The risk was similar to that in smokers, implying that smokers will not reduce their risk of type 2 diabetes by changing to snus use. The results also support the notion that nicotine increases the risk of type 2 diabetes.


  • S. Carlsson
  • T. Andersson
  • M. Araghi
  • M. R. Galanti
  • A. Lager
  • M. Lundberg
  • Peter M Nilsson
  • M. Norberg
  • N. L. Pedersen
  • Y. Trolle Lagerros
  • C. Magnusson
External organisations
  • Karolinska Institutet
  • Stockholm County Council
  • Umeå University
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Endocrinology and Diabetes
  • Substance Abuse


  • Meta-analysis, Public health, Tobacco, Type 2 diabetes
Original languageEnglish
Pages (from-to)398-406
JournalJournal of Internal Medicine
Issue number4
Early online date2017 Feb 6
Publication statusPublished - 2017
Publication categoryResearch